Clinical Challenge #1: Diminished Sexual Desire

QUESTION

A 32-year-old married woman has diminished sexual desire. Married five years, she has a few sexual fantasies, no longer masturbates, and does not initiate sex with her husband. When having intercourse with her husband, whom she loves very much, she enjoys it and does reach orgasm. However, her seemingly lack of interest is interfering with their relationship. Her physical examination and all of her laboratory tests are within normal limits. The medication most likely to increase her desire is

A. Testosterone

B. Estrogen

C. Bupropion

D. Flibanserin

ANSWER

D. Flibanserin

Flibanserin is the only FDA-approved medication for hypoactive sexual desire disorder (HSDD) in premenopausal women. Studies have shown testosterone is effective in increasing desire and orgasm in postmenopausal women. About 10-20% of women face this problem and some say HSDD outnumbers men with sexual problems, according to studies. Flibanserin is classified as a 5-HT serotonin receptor agonist and a dopamine D4 receptor partial agonist. It is a non-hormonal agent that in essence increases dopamine and noradrenalin while reducing serotonin in the brain.

RELATED TOPICS COVERED AT THE 2016 MEETING

Gain expert perspective on the diagnosis and treatment of sexual dysfunction at the 2016 meeting.